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Miller D, DeHerrera-Smith D, Sharp TA, Gilbert ED. Introducing the Harm Reduction Collaboration Framework for Policy, Systems, and Environmental Change. HEALTH EDUCATION & BEHAVIOR 2024; 51:408-415. [PMID: 37129271 DOI: 10.1177/10901981231165338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A revised way of thinking is essential for promoting harm reduction strategies and reducing the negative implications of injection drug use (IDU). Despite the growth of harm reduction approaches in the United States, there is limited guidance for designing and implementing multi-sector efforts that address the external determinants that promote and facilitate IDU. Current frameworks fail to acknowledge the individual's role and influence in multi-sector change. To address the multifaceted nature of IDU, we must address the complex relationship between people who inject drugs (PWID) and their external environment. As part of a community-academic partnership, a framework was developed to address the gaps in current theoretical models and community practice. Our Harm Reduction Collaboration Framework (HRCF) accepts PWID as key stakeholders and presents a practical framework in which PWID and community organizations partner in decision making to influence policy, systems, and environmental change. We provide examples of two organizations that have made substantive changes in implementing harm reduction strategies in their communities by utilizing the HRCF.
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Affiliation(s)
- Devin Miller
- Colorado School of Public Health, Aurora, CO, USA
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Lewis NM, Smeltzer RP, Baker TJ, Sahovey AC, Baez J, Hensel E, Poole B, Stewart C, Cogan AG, Bullard M, Taylor JL. Feasibility of paying people who use drugs cash to distribute naloxone within their networks. Harm Reduct J 2024; 21:42. [PMID: 38365734 PMCID: PMC10870496 DOI: 10.1186/s12954-024-00947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Immediate access to naloxone is needed to prevent fatal opioid-related overdoses in the presence of fentanyl analogs saturating the opioid supply. Peer models engage impacted populations who are not accessing naloxone through standard venues, yet compensating peers who utilize syringe service programs with cash stipends to distribute naloxone within networks of people who use drugs is not well described. METHODS As part of the HEALing Communities Study, syringe service program-based interventions were developed in Holyoke and Gloucester, MA, which paid people who use drugs ("peers") cash to distribute naloxone. Early program outcomes were evaluated for the time each program was funded within the HCS study period. RESULTS During 22 study-months of observation, peers in two communities distributed 1104 naloxone kits. The total cost of peer compensation for program delivery was $10,510. The rate of peer-distributed naloxone per 100 K population reached 109 kits/mo and 222 kits/mo in the two communities. Participating peers addressed gaps in harm reduction outreach and distributed naloxone and other harm reduction equipment to individuals who were not syringe service program participants, expanding organizational reach. Being compensated with unrestricted cash stipends supported dignity and acknowledged peers' work in overdose prevention. CONCLUSION The underutilization of compensated peer models is often attributed to funding and organizational barriers. These programs demonstrate that providing cash stipends to peers is feasible and expanded naloxone distribution at two existing syringe service programs. Providing cash stipends for peers who engage in secondary naloxone distribution offers promise in delivering naloxone to people not accessing syringe services.
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Affiliation(s)
- Nikki M Lewis
- Berkshire Regional Planning Commission, Pittsfield, MA, USA.
| | - Rebecca P Smeltzer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trevor J Baker
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Andrea C Sahovey
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Justine Baez
- ONESTOP Harm Reduction Center, Gloucester, MA, USA
| | | | | | | | - Allyson G Cogan
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Mackenzie Bullard
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jessica L Taylor
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, USA
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Bosak J, Messersmith L, Bryer C, Drainoni M, Goodman D, Adams M, Barry T, Flanagan C, Flanagan V, Wolff K, Declercq E. "They just looked at me like I was human": The experiences of parenting women and providers with substance use disorder treatment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209240. [PMID: 38061633 DOI: 10.1016/j.josat.2023.209240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program. DESIGN AND METHODS The study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC). RESULTS We conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal). CONCLUSION This research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.
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Affiliation(s)
- J Bosak
- Community Health Services, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States; Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States; Dartmouth Geisel School of Medicine, 1 Medical Drive, Lebanon, NH 03766, United States.
| | - L Messersmith
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States
| | - C Bryer
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - M Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States; Department of Health Law Policy & Management, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, United States
| | - D Goodman
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States; Dartmouth Geisel School of Medicine, 1 Medical Drive, Lebanon, NH 03766, United States
| | - M Adams
- Families Flourish Northeast, P.O Box 20, Enfield Center, NH 03749, United States
| | - T Barry
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - C Flanagan
- Families Flourish Northeast, P.O Box 20, Enfield Center, NH 03749, United States
| | - V Flanagan
- Dartmouth Hitchcock Medical Center, 1 Medical Drive, Lebanon, NH 03766, United States
| | - K Wolff
- Independent Researcher, 566 Hanover Center Rd, Hanover, NH 03755, United States
| | - E Declercq
- Community Health Services, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, United States
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Bosak J, Drainoni M, Bryer C, Goodman D, Messersmith L, Declercq E. 'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme. Health Expect 2023; 27:e13908. [PMID: 37920874 PMCID: PMC10726284 DOI: 10.1111/hex.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. METHODS A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. RESULTS The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges. CONCLUSION These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. PATIENT CONTRIBUTION Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.
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Affiliation(s)
- Julie Bosak
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Mari‐Lynn Drainoni
- Department of Medicine, Section of Infectious DiseasesBoston University Aram V. Chobanian & Edward Avedisian School of MedicineBostonMassachusettsUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Cheri Bryer
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Dartmouth Geisel School of MedicineLebanonNew HampshireUSA
| | - Daisy Goodman
- Dartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Department of Health Law Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Lisa Messersmith
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Eugene Declercq
- Community Health ServicesBoston University School of Public HealthBostonMassachusettsUSA
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Sheikhan NY, Kuluski K, McKee S, Hiebert M, Hawke LD. Exploring the impact of engagement in mental health and substance use research: A scoping review and thematic analysis. Health Expect 2023; 26:1806-1819. [PMID: 37282732 PMCID: PMC10485342 DOI: 10.1111/hex.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND There is growing evidence demonstrating the impact of engaging people with lived experience (PWLE) in health research. However, it remains unclear what evidence is available regarding the impact of engagement specific to mental health and substance use research. METHODS A scoping review of three databases and thematic analysis were conducted. Sixty-one articles that described the impact of engagement in mental health and substance use research on either individual experiences or the research process were included. RESULTS Key topics include (a) the impact of engagement on individual experiences; (b) the impact of engagement on the research process; and (c) facilitators and barriers to impactful engagement. Studies largely focused on the perceived positive impact of engagement on PWLE (e.g., personal and professional growth, empowering and rewarding experience, feeling heard and valued), researchers (e.g., rewarding experience, deeper understanding of research topic, changes to practice), and study participants (e.g., added value, fostered a safe space). Engagement activities were perceived to improve facets of the research process, such as improvements to research quality (e.g., rigour, trustworthiness, relevance to the community), research components (e.g., recruitment), and the research environment (e.g., shifted power dynamics). Facilitators and barriers were mapped onto the lived experience, researcher, team, and institutional levels. Commonly used terminologies for engagement and PWLE were discussed. CONCLUSION Engaging PWLE-from consultation to co-creation throughout the research cycle-is perceived as having a positive impact on both the research process and individual experiences. Future research is needed to bring consistency to engagement, leverage the facilitators to engagement, and address the barriers, and in turn generate research findings that have value not only to the scientific community, but also to the people impacted by the science. PATIENT OR PUBLIC CONTRIBUTION PWLE were engaged throughout the scoping review process, including the screening phase, analysis phase, and write-up phase.
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Affiliation(s)
- Natasha Y. Sheikhan
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Kerry Kuluski
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health Partners
| | - Shelby McKee
- Centre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Lisa D. Hawke
- Centre for Addiction and Mental HealthTorontoOntarioCanada
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Maguet S, Laliberte N, Moore L, Milkovich T, Burmeister C, Scow M, Sproule W, Dove N, Martens S. An evaluation of the Compassion, Inclusion, and Engagement initiative: learning from PWLE and communities across British Columbia. Harm Reduct J 2023; 20:89. [PMID: 37452328 PMCID: PMC10347729 DOI: 10.1186/s12954-023-00819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The Compassion, Inclusion and Engagement initiative (CIE) was a social contact intervention that operated in British Columbia between 2015 and 2021. The primary objective of CIE was to increase the participation of people with lived experience of substance use (PWLE) in the planning, design, implementation, and evaluation of harm reduction supports and services. CASE PRESENTATION CIE used the developmental evaluation methodology outcome mapping to define and measure progress towards its goals. Developmental evaluation emphasizes learning in contrast to other forms of evaluation which are often more focused on determining the value or success of a project or programme based on predetermined criteria. Outcome mapping is a relational practice which acknowledges that change is achieved by an initiative's partners and the role of the initiative is to provide access to resources, ideas and opportunities that can facilitate and support change. CONCLUSIONS Through the implementation and evaluation of CIE, it became clear that directly supporting PWLE facilitated more meaningful and lasting change than solely working to improve the health and social services that supported them. The impacts of the CIE initiative extend far beyond the outcomes of any of the dialogues it facilitated and are largely the result of an increase in social capital. CIE engagements created the opportunity for change by inviting people most affected by the toxic drug supply together with those committed to supporting them, but their ability to bring about systemic change was limited. Both PWLE and service providers noted the lack of support to attend CIE engagements, lack of support for actions that came from those engagements, and lack of PWLE inclusion in decision-making by health authorities as limiting factors for systemic change. The lack of response at a systemic level often resulted in PWLE carrying the burden of responding to toxic drug poisonings, often without resources, support, or compensation.
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Affiliation(s)
- Sally Maguet
- Provincial Health Services Authority, Vancouver, Canada.
| | | | - Laura Moore
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | - Marnie Scow
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Naomi Dove
- BC Centre for Disease Control, Vancouver, Canada
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Hawke LD, Sheikhan NY, Roberts S, McKee S. Research evidence and implementation gaps in the engagement of people with lived experience in mental health and substance use research: a scoping review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:32. [PMID: 37170357 PMCID: PMC10176886 DOI: 10.1186/s40900-023-00442-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is growing recognition that engaging people with lived experience (PWLE) in mental health and substance use research improves the quality of the research in terms of relevance to the population and the feasibility of the work. Engagement also provides positive opportunities for research teams and the PWLE engaged. However, there are many gaps in the research on PWLE engagement. This scoping review synthesizes the gaps in the implementation of PWLE engagement and in the research on engagement as presented by research teams engaging PWLE in their work. METHOD A systematic electronic database search was conducted in 2022 for published articles on PWLE engagement in mental health and substance use research. Potential articles were screened for relevance. The search led to 49 final articles included in the review. The 49 articles were then coded using codebook thematic analysis to answer two research questions: (1) What are the research evidence gaps regarding the engagement of PWLE in mental health and substance use research?; and (2) What are the gaps in implementing PWLE engagement in mental health and substance use research? PWLE were engaged in the conduct of this review. RESULTS Results showed that research evidence gaps include further work on conceptualizing engagement; developing resources, tools, and practice recommendations to support research teams; increasing diversity in evaluations of engagement; and evaluating engagement, including its impact on the research, on PWLE, and on researchers. Implementation gaps included several broader institutional gaps and gaps in the day-to-day practice of engagement. CONCLUSIONS Despite progress in PWLE engagement in mental health and substance use research in recent years, research evidence and implementation gaps remain. Research teams are encouraged to consider these gaps and conduct research and implementation activities to address them in a rigorous manner.
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Affiliation(s)
- Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| | - Natasha Y Sheikhan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Sara Roberts
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shelby McKee
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Poudel P, Kong A, Hocking S, Whitton G, Srinivas R, Borgnakke WS, George A. Oral health-care needs among clients receiving alcohol and other drugs treatment-A scoping review. Drug Alcohol Rev 2023; 42:346-366. [PMID: 36529982 PMCID: PMC10107646 DOI: 10.1111/dar.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022]
Abstract
ISSUES Poor oral health is a significant problem among people who access alcohol and other drugs (AOD) health services, yet little is known about their oral health-care needs and whether any interventions and guidelines are implemented within AOD treatment services. APPROACH A scoping review was conducted to identify scientific literature in three focus areas: oral health knowledge, attitudes and practices of clients and clinicians at AOD-related services; oral health guidelines for AOD clinicians; and interventions that describe clinicians promoting oral health among clients. KEY FINDINGS Thirty-two reports were identified. Twenty-three studies focused on the oral health knowledge, attitudes and practices of AOD clients, but none of the studies explored perspectives of clinicians. Seven clinical practice guidelines were identified but recommendations varied. Only two interventions in which an AOD clinician promoted oral health were identified. IMPLICATIONS Most reports provided insight into the perspectives of clients accessing AOD treatment services. Little evidence demonstrated that clinical practice guidelines were being implemented into practice, or that oral health promotion was part of the tasks of AOD clinicians. CONCLUSION This review identified oral health knowledge gaps and perceived poor attitudes that appeared to be reflected in certain oral health practices among clients. This finding indicates a need to educate clients about oral health while receiving AOD treatment. There was an absence of research about the needs for AOD clinicians to advocate for good oral health, and little evidence exists about effective interventions that could enhance integrating oral health care into AOD treatment services.
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Affiliation(s)
- Prakash Poudel
- eHealth New South Wales, Sydney, Australia
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Ariana Kong
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | - Gilbert Whitton
- Drug Health Services, South Western Sydney Local Health District, Sydney, Australia
| | - Ravi Srinivas
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Oral Health Services, South Western Sydney Local Health District, Sydney, Australia
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, School of Dentistry, The University of Michigan, Ann Arbor, USA
| | - Ajesh George
- Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
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Horwood J, Pithara C, Lorenc A, Kesten JM, Murphy M, Turner A, Farr M, Banks J, Redwood S, Lambert H, Donovan JL. The experience of conducting collaborative and intensive pragmatic qualitative (CLIP-Q) research to support rapid public health and healthcare innovation. FRONTIERS IN SOCIOLOGY 2022; 7:970333. [PMID: 36189441 PMCID: PMC9520785 DOI: 10.3389/fsoc.2022.970333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
A key challenge for qualitative methods in applied health research is the fast pace that can characterize the public health and health and care service landscape, where there is a need for research informed by immediate pragmatic questions and relevant findings are required quickly to inform decision-making. The COVID-19 pandemic accelerated the pace at which evidence was needed to inform urgent public health and healthcare decision-making. This required qualitative researchers to step up to the challenge of conducting research at speed whilst maintaining rigor and ensuring the findings are credible. This article illustrates how working with multidisciplinary, collaborative teams and the tailoring of qualitative methods to be more pragmatic and efficient can provide timely and credible results. Using time-limited case studies of applied qualitative health research drawn from the work of the Behavioral and Qualitative Science Team from the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), we illustrate our collaborative and intensive pragmatic qualitative (CLIP-Q) approach. CLIP-Q involves (i) collaboration at all stages of the design, conduct and implementation of projects and, where possible, co-production with people with lived experience, (ii) an intensive team-based approach to data collection and analysis at pace, and (iii) pragmatic study design and efficient strategies at each stage of the research process. The case studies include projects conducted pre COVID-19 and during the first wave of the pandemic, where urgent evidence was required in weeks rather than months to inform rapid public health and healthcare decision making.
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Affiliation(s)
- Jeremy Horwood
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Christalla Pithara
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ava Lorenc
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Joanna M. Kesten
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Mairead Murphy
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The South West Academic Health Science Network, Exeter, United Kingdom
| | - Andrew Turner
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michelle Farr
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jon Banks
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sabi Redwood
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Helen Lambert
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
| | - Jenny L. Donovan
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - NIHR ARC West Behavioural and Qualitative Science Team
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Mezaache S, Briand-Madrid L, Rahni L, Poireau J, Branchu F, Moudachirou K, Wendzinski Y, Carrieri P, Roux P. A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation. BMC Infect Dis 2021; 21:211. [PMID: 33632143 PMCID: PMC7905764 DOI: 10.1186/s12879-021-05895-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Inconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID. Methods A mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study. Results Among the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention. Conclusions ABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention’s educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention’s efficacy through increased hand hygiene frequency and a reduced risk of infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05895-1.
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Affiliation(s)
- Salim Mezaache
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France. .,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Laélia Briand-Madrid
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Linda Rahni
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | - Khafil Moudachirou
- Aides, Béziers & Pantin, France.,Laboratoire de Recherche Communautaire, Coalition Plus, Pantin, France
| | | | - Patrizia Carrieri
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Kesten J, Ward Z, Hancock E, Ayres R, Neale J, Hussey D, Hickman M, Vickerman P. Response to Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs. Addiction 2020; 115:2407-2408. [PMID: 32533576 DOI: 10.1111/add.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Joanna Kesten
- NIHR Applied Research Collaboration (ARC) West, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.,NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | | | - Matthew Hickman
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Agot K, Lutnick A, Shapley-Quinn MK, Ahmed K, Okello T, van der Straten A. "I felt like a TRIO champion": end-user perspectives on their role as co-designers of multi-purpose technologies. Gates Open Res 2020; 4:163. [PMID: 33870103 PMCID: PMC8028846 DOI: 10.12688/gatesopenres.13182.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The likelihood that research will be relevant to and accepted by end-users and their communities is enhanced when the perspectives of both the "researchers" and the "researched" are considered. The Tablets, Ring, Injections as Options (TRIO) Study, conducted with young women in Kenya and South Africa, assessed the acceptability and preferences of three placebo-only multi-purpose technology (MPT) forms for prevention of HIV and unintended pregnancy. The objective of this analysis was to assess whether, and if so how, the women participating in the TRIO Study perceived themselves as co-designers of the three MPT products. Methods: We conducted 55 in-depth interviews, 6 focus group discussions, and 5 dissemination workshops with TRIO Study participants. Woven throughout these activities were questions and opportunities for participants to reflect on their role in the study, and to what extent they identified with their role as a co-designer. Qualitative data from these activities were analyzed thematically. Results: The analysis revealed four key themes about what resulted in the women's views as co-designers: altruism, respectful treatment, agency, and reciprocity. The women were aware of their role in determining what end-users would and would not prefer and were motivated by a desire to help themselves and others. They recognized their role as co-designers and cited being treated well by study staff, being given a chance to make choices during the study period, and being recognized as equal partners of the researchers as the main reasons. Conclusions: If prevention products are going to be successfully developed, end-users and researchers must work hand in hand. Engaging participants meaningfully as co-designers in product development research can be a powerful tool in the effort to ensure new prevention products brought to market are acceptable to the population of interest.
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Affiliation(s)
- Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Alexandra Lutnick
- Behavioral and Urban Health Program, RTI International, San Francisco, California, USA
| | | | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, Gauteng, South Africa
| | - Timothy Okello
- Impact Research and Development Organization, Kisumu, Kenya
| | - Ariane van der Straten
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, California, USA
| | - The TRIO Study Team
- Impact Research and Development Organization, Kisumu, Kenya
- Behavioral and Urban Health Program, RTI International, San Francisco, California, USA
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
- Setshaba Research Centre, Soshanguve, Gauteng, South Africa
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, California, USA
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